曲马多联合氟哌利多治疗无痛人工流产中米索前列醇宫颈上药引起寒战的效果观察

目的观察曲马多联合氟哌利多治疗无痛人工流产中米索前列醇宫颈上药引起寒战的效果。方法对26例超声引导下无痛人工流产孕妇因使用米索前列醇宫颈上药引起寒战应用曲马多合并氟哌利多治疗的效果进行观察分析。结果优25例（96.2%）;良1例（3.8%）;差0例（0）。结论曲马多联合氟哌利多治疗人工流产中米索前列醇宫颈上药引起寒战的效果显著,减轻了患者手术的痛苦,极大提高了人工流产的安全性与质量,值得在临床推广和应用。     

The occurrence of shivering in cardiac arrest survivors undergoing therapeutic hypothermia is associated with a good neurologic outcome

Background

The incidence of shivering in cardiac arrest survivors who undergo therapeutic hypothermia (TH) is varied. Its occurrence is dependent on the integrity of multiple peripheral and central neurologic pathways. We hypothesized that cardiac arrest survivors who develop shivering while undergoing TH are more likely to have intact central neurologic pathways and thus have better neurologic outcome as compared to those who do not develop shivering during TH.

Methods

Prospectively collected data on consecutive adult patients admitted to a tertiary center from 1/1/2007 to 11/1/2010 that survived a cardiac arrest and underwent TH were retrospectively analyzed. Patients who developed shivering during the cooling phase of TH formed the “shivering” group and those that did not formed the “non-shivering” group. The primary end-point: Pittsburgh Cerebral Performance Category (CPC) scale; good (CPC 1–2) or poor (CPC 3–5) neurological outcome prior to discharge from hospital.

Results

Of the 129 cardiac arrest survivors who underwent TH, 34/94 (36%) patients in the “non-shivering” group as compared to 21/35 (60%) patients in the “shivering” group had good neurologic outcome (P = 0.02). After adjusting for confounders using binary logistic regression, occurrence of shivering (OR: 2.71, 95% CI 1.099–7.41, P = 0.04), time to return of spontaneous circulation (OR: 0.96, 95% CI 0.93–0.98, P = 0.004) and initial presenting rhythm (OR: 4.0, 95% CI 1.63–10.0, P = 0.002) were independent predictors of neurologic outcome.

Conclusion

The occurrence of shivering in cardiac arrest survivors who undergo TH is associated with an increased likelihood of good neurologic outcome as compared to its absence.     

布托啡诺预防全麻术后寒战的临床观察

目的探讨布托啡诺预防全麻术后寒战的效果及安全性。方法 120例ASAⅠ～Ⅱ级择期全麻手术患者,随机均分为三组:布托啡诺组(B组)、曲马多组(T组)、生理盐水组(N组)。术毕B组静脉注入布托啡诺1mg、T组注入曲马多1mg/kg、N组注入生理盐水5ml,记录注药后5、10、30min寒战反应变化,MAP、HR、SPO2变化及不良反应。结果 B组及T组注药后5、10、30min寒战患者数都明显低于N组(P<0.01),B组、T组比较差异无统计学意义(P>0.05);B组、T组用药前后MAP、HR、SPO2差异无统计学意义(P>0.05);T组恶心呕吐发生率高于B组,差异有统计学意义(P<0.05);B组嗜睡发生率稍高于T组,差异无统计学意义(P>0.05);两组均未发生呼吸抑制。结论布托啡诺可有效预防全麻术后寒战发生,且不良反应小。     

右美托咪啶治疗全身麻醉后重度寒战效果观察

目的观察右美托咪啶（Dexmedetomidine,Dex）静脉注射治疗全身麻醉后重度寒战的安全性和有效性。方法选择静吸复合全身麻醉行胸、腹部、泌尿、骨科手术后麻醉复苏早期出现寒战、强度分级为4级的患者60例。ASAⅠ～Ⅱ级,年龄20～60岁,体重50～70kg,随机分为两组,均在出现重度寒战时注药,Ⅰ组（Dex组）给予右美托咪啶0.2～0.3μg/kg,用生理盐水稀释至10ml,当寒战完全停止时（显效）停药;Ⅱ组（曲马多组）给予曲马多1～2mg/kg。观察两组患者寒战的转归情况。结果①Dex治疗全身麻醉后重度寒战的效果明显优于曲马多;②Dex小剂量静脉缓慢注射治疗寒战时,患者血流动力学稳定,有一定的镇静作用且无头昏、恶心呕吐等症状,与曲马多比较差异有统计学意义（P〈0.05）;③Dex治疗寒战术中无寒战再发征象。结论 Dex静脉注射能迅速解除寒战,降低寒战阈值,可减少寒战复发,安全可靠,有一定的临床价值。     

术中保温对预防经尿道前列腺电切术患者发生寒战的观察及体会

目的:观察术中保温对预防经尿道前列腺电切术患者发生寒战的效果。方法:将24例经尿道前列腺电切术患者随机分为保温组和对照组,每组各12例,保温组患者采用加温至38℃灌洗液(生理盐水)进行膀胱冲洗,以及给患者予保温护理;对照组患者术中不采用任何保温措施,使用室温灌洗液进行膀胱冲洗。通过测定术前及术后核心体温,比较2组发生寒战情况。结果:保温组患者术中体温维持稳定,手术前后体温无明显变化,平均降低0.15℃,对照组患者术中体温显著下降,与术前及保温组比较均显著下降1.7～3.0℃(P﹤0.05),而保温组寒战发生率显著低于对照组(P﹤0.01)。结论:TURP采用术中保温措施可维持患者体温的恒定,有效降低寒战的发生率,维持患者生命特征的稳定,减少手术并发症及促进术后康复,提高患者的舒适度。     

冲洗液对经尿道前列腺汽化电切术中患者体温、寒颤的影响

目的探讨冲洗液对经尿道前列腺汽化电切术(TUVP)患者围术期体温、寒颤的影响。方法将90例TUVP患者随机分为试验组和对照组各45例。试验组采用加温冲洗液,对照组采用室温冲洗液。分别于麻醉前、麻醉后15、30、60、120min和术毕时分别记录直肠温、心率及平均动脉血压(MAP)和低体温、寒颤的发生情况。结果硬膜外阻滞后30min直肠温逐渐升高,之后逐渐下降,试验组下降幅度低于对照组(P<0.05);对照组患者术终直肠温较基础值低(P<0.01)。2组麻醉后30、60、90min心率水平较基础值降低,30、60、90min及术毕时MAP水平低于基础值,差异均有统计学意义(P<0.05)。试验组低体温、寒颤的发生率明显低于对照组,差异均有统计学意义(P<0.05或P<0.01)。结论冲洗液加温能有效降低TUVP术中低体温、寒颤的发生率,更好地维持患者心率和血压的稳定。     

布托啡诺预防脊髓麻醉后寒战反应的临床观察

目的观察布托啡诺对脊髓麻醉后寒战反应发生的预防作用。方法选择ASAⅠ～Ⅱ级择期行子宫全切或次全切除患者90例,随机分为3组,每组30例。分别在脊髓麻醉后,切皮前静脉滴注2 mL布托啡诺0.5 mg（B1组）、布托啡诺0.3 mg（B2组）和生理盐水（C组）。观察3组寒战反应及恶心、呕吐、嗜睡等不良反应的发生率。结果 B1、B2组和C组寒战例数分别为1、3、10例。B1组与其他两组相比,差异有统计学意义。结论布托啡诺0.5 mg单次静脉注射,可以有效预防脊髓麻醉后的寒战反应。     

布托啡诺、哌替啶与曲马多治疗围麻醉期病人寒战的效果

目的：观察布托啡诺、哌替啶与曲马多三种药物治疗围麻醉期病人寒战的效果。方法：60例ASAⅠ～Ⅱ级麻醉期间发生寒战反应的病人,随机分为三组,每组20例：布托啡诺组,静脉注射布托啡诺0．02mg／kg;哌替啶组,静脉注射哌替啶0．5mg／kg;曲马多组,静脉注射曲马多1mg／kg。观察寒战程度及治疗效果,用药后镇静评分及不良反应。结果：布托啡诺组和曲马多组寒战治疗有效率高于哌替啶组（P〈0．01）;哌替啶组和曲马多组的镇静评分显著高于布托啡诺组（P〈0．05）;曲马多组恶心呕吐发生率高于哌替啶组和布托啡诺组（P〈0．05）。结论：布托啡诺与曲马多可有效控制麻醉后的寒战反应,但布托啡诺镇静作用较强,而曲马多增加恶心呕吐发生率,临床上应根据患者的情况合理应用相应药物。     

不同剂量曲马朵治疗全身麻醉术后寒战疗效比较

目的 比较不同剂量曲马朵治疗全身麻醉术后寒战的临床疗效以及不良反应发生情况,探讨曲马朵治疗全身麻醉术后寒战的适宜剂量.方法 选取进行全身麻醉腹部手术的患者87例,并按患者意愿分为五组.对照组17例不给予曲马朵治疗;观察1组17例静脉注射曲马朵0.5 mg/kg进行治疗;观察2组17例静脉注射曲马朵1.0 mg/kg进行治疗;观察3组18例静脉注射曲马朵1.5 mg/kg进行治疗;观察4组18例静脉注射曲马朵2.0 mg/kg进行治疗.治疗后,对发生寒战患者的寒战程度进行评分,观察五组患者治疗前后寒战评分的差异,比较不同剂量曲马朵治疗全身麻醉术后寒战的临床疗效以及不良反应发生情况.结果 使用曲马朵治疗可明显降低患者的寒战评分,提高疗效,各组不良反应发生率分别为0.00％、0.00％、0.00％、5.56％、61.11％,总有效率分别为11.76％、70.59％、100.00％、94.44％、77.78％.观察2组的临床疗效明显优于其他组,差异有统计学意义(x2 =9.85,P＜0.05).结论 曲马朵使用剂量为1.0 mg/kg或1.5 mg/kg,既能显著提高全身麻醉术后寒战的临床疗效,又能减少不良反应的发生,是临床上治疗该病的最佳剂量,值得在临床上推广使用.     

Nonpharmacologic approach to minimizing shivering during surface cooling: A proof of principle study

Purpose

This study had 2 objectives: (1) to quantify the metabolic response to physical cooling in febrile patients with systemic inflammatory response syndrome (SIRS) and (2) to provide proof for the hypothesis that the efficiency of external cooling and the subsequent shivering response are influenced by site and temperature of surface cooling pads.

Methods

To quantify shivering thermogenesis during surface cooling for fever, we monitored oxygen consumption (VO₂) in 6 febrile patients with SIRS during conventional cooling with cooling blankets and ice packs. To begin to determine how location and temperature of surface cooling influence shivering, we compared 5 cooling protocols for inducing mild hypothermia in 6 healthy volunteers.

Results

In the patients with SIRS, core temperature decreased 0.67°C per hour, all patients shivered, VO₂ increased 57.6%, and blood pressure increased 15% during cooling. In healthy subjects, cooling with the 10°C vest was most comfortable and removed heat most efficiently without shivering or VO₂ increase. Cooling with combined vest and thigh pads stimulated the most shivering and highest VO₂ and increased core temperature. Reducing vest temperature from 10°C to 5°C failed to increase heat removal secondary to cutaneous vasoconstriction. Capsaicin, an agonist for the transient receptor potential cation channel subfamily V member 1 (TRPV1) warm-sensing channels, partially reversed this effect in 5 subjects.

Conclusions

Our results identify the hazards of surface cooling in febrile critically ill patients and support the concept that optimization of cooling pad temperature and position may improve cooling efficiency and reduce shivering.